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Sample form
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Immigration Physical Check

The form must be signed at the clinic.
New Zealand information sheet need to submit the relevant visa department within 3 months from the date of the medical examination
After you submitted the form, the part below the line needs to be printed and handwritten.
    (New Zealand only)Please choose the form you need and sign
  • Form 1007, signature

  • Form 1096, signature

  • Form 1201, signature


    (Canada only )Please sign to confirm that you’re going to undertake up-front medical examination for Canadian visa
  • Signature


  • (If applicable )Please sign to confirm that you have received the medical report or information sheet:

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